Clinical Endoscopy

원저 : 신생아 및 영아 환아에서 상부위장관 내시경검사의 임상적 유용성 ( The Clinical Usefulness of Esophagogastreduodenoscopy in Neonates and Infants ): Korean J Gastrointest Endosc 2000;20(6):425-430. Published online November 30, 1999

Abstract PDF: Background
/Aims: Endoscopic examination of upper gastrointestinal tract disease in infancy and childhood was introduced 2 decades ago. However, clinical indication, premedication, endoscopic features, and practical problems have been infrequently reported in neonate and infants, Therefore, the usef'ulness and problems of endoscopy in these pediatric patients was evaluated. Methods: Twelve pediatric patients who underwent endos-copic examination which involved a choledochoscope, bronchoscope, and gastrofibroscope included 8 neonates and 4 infants who suffered from gastrointestinal symptoms. Drugs for premedication were chloral hydrate, diazepam, midazolam and ketamine in single or combined administration. Results: Clinical manifestations were hematemesis (67%), melena (42%), vomiting (8%), weight loss (8%), fever (8%) and irritability (8%). Indica-tions for endoscopic examination were upper gastrointestinal Weeding (67%), upper gastrointestinal obstruction (8%), acute drug intoxication (8%), foreign bodies in the stomach (8%) and evaluation for varix (8%). Endo-scopic findings revealed a gastric ulcer (48%), acute gastric mucosal lesion (8/<), external compression on the duodenum (8%), a gastric foreign body (8%), acute esophago-gastritis (8%) and esophageal and gastric varix (8%). Therapeutic endoscopy was performed in 2 patients, One case of hypoxia occurred during diagnostic endoscopy. Conclusions: Endoseopic examination of the upper gastrointestinal tract is a useful and safe proce-dure to detect diseases in neonates and infants if it is done by experienced endocopists and in the circumstances of adequate premedication. (Korean J Gastrointes4 Kndwc 200;20:425-430)

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원저 : 소화성 궤양 출혈에서 열탐침 지혈법 후 재출혈의 위험인자 (The Risk Factors for Rebleeding with Heat Probe Thermocoagulation in Bleeding Peptie Ulcer Patients: Korean J Gastrointest Endosc 2000;20(6):431-436. Published online November 30, 1999

Abstract PDF: Background
/Aims: The precise rebleeding rate and risk factors of rebleeding after heat probe thermocoagulation in peptic ulcer patients with bleeding are not clear and still need to be evaluated. If we could identify the pre-dictors for rebleeding, the mortality rate might be loweted with early retreatment or surgery in these high risk group. Methods: The 94 patients in whom heat probe was applied were enrolled and the 18 patients with bleeding tendencies. Initial hemostasis was defined as hemostasis persisting for 24 hours post-treatment and permanent hemostasis as absence of bleeding for 7 days after therapy. Rebleedig was defined as oozing or spurting hemorrhage in the ulcer base and/or unstable vital signs and continuting tarry or bloody stool or hematemesis after therapy. Results: In 35 patients with active bleeding sign, initial hemostasis was obtained in 30 (85.7%) patients. After having achieved initial hemostasis, 9 (30.0%) patients rebled. In 41 ulcer patients with non-bleeding visible vessel, 40 cases (97.6%) achieved successful pre-vention of rebleeding. No evident complication was observed. With univariate analysis, bleeding ulcer patients with spurting and oozing hemorrhage had a higher re-bleeding rate than those with non-bleeding visible vessel. Conclusions: The heat probe thermocoagulaton is relative safe and effective procedure to protect bleeding in pectic ulcer patients with non-bleeding visible vessel, but insufficient to hemostasis in bleeding peptic ulcer patients with spurting or oozing in ulcer base. Spurting and oozing hemorrhage are the only risk factors of rebleeding after initial hemostasis with heat probe thermocoagulation in peptic ulcer patients with bleeding.

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원저 : 점막하종양양 벽외성 압박의 진단에 있어서 내시경적 초음파차단층촬영술 ( Diagnostic Usefulness of Eedoscopic Ultrasongraphy for Extraluminal Compressions Mimicking Submucosal Tumors ): Korean J Gastrointest Endosc 2000;20(6):437-442. Published online November 30, 1999

Abstract PDF: Background
/Aims: When a submucosal lesion is discovered through an upper gastrointestinal endoscopy, it may be often difficult to differentiate an extra-gastric compression from a true submucosa1 tumor (SMT). An endoscopic ultrasonography (EUS) provides information about the relationship between a lesion and the gastric or esophageal wall. Furthermore, EUS helps in identifying the compression caused by surrounding organs. The diagnostic usefulness of EUS for extralumina1 compressed lesion was assessed. Methods: The 261 patients who received an endoscopic diagnosis of submucosal tumors had EUS examinations performed. The results of EUS to additional diagnostic procedures such as UGI, USG, CT scan or tissue biopsy were then compared. Results: Of 261 patients who received endoseopic diagnosis as SMT, extraluminal compression existed in 46 (17.6%) cases and true intramural lesion were found in 215 (82.4%) cases on EUS. The causes of extraluminal compression are lymph nodes (2 case.), the gallbladder (12 cases), the pancreas (9 cases), the spleen (6 cases), a pancreatic pseudocyst (5 cases), pancreatic cancer (2 cases), a hepatic cyst (2 cases), the left lobe of the liver (4 cases), hepatoma (1 case), a mesenteric tumor (2 caws) and a splenic vein (1 case). Conclusions: EUS is considered to be a useful diagnostic method not only for differential diagnosis of extraluminal compression from true SWT, but also for clarifying the cause of extraluminal compressed lesions. (Korean J Gastrointest Endosc 2000;20:437--442)

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원저 : 췌장의 Intreaductal Papillary Mucinous Tumor:그 아형에 따른 임상적, 방사선학적 및 병리학적 소견의 비교 ( An Intraductal Papillary Mucinous Tumors (IPMT) of the Pancreas: Clinical, Radiologie, and Pathologie Findings Acccrding to Its Subtypes ): Korean J Gastrointest Endosc 2000;20(6):443-448. Published online November 30, 1999

Abstract PDF: Background
s/Aims: Patients with a branch duct type intraductal papillary mucinous tumor (IPMT) of the pancreas with hyperplasia are suggested to be followed up without resection. The aims of this study were to compare the clinical, radiologic, and pathologic findings among the subtypes of IPMT and to find the factors that could predict a hyperplastic lesion preoperatively. Methods: Twenty two patients with IPMT of the pancreas who underwent surgical resection were investigated. The subtypes of IPMT were classified into the main duct type (7 patients), branch duct type (6 patients), and combined type (9 patients) based on the pathologic findings of the surgical specimens. The clinical, radirologic, and pathoiogic findings of each subtype were analyzed. Results: Asymptomatic patients were more common in the branch duct type of IPMT (p=0.01). The diameter of the main pancreatic duct was <7 mm in most of the branch duet types of IPMT (5/6). Hyperplastic lesions were more likely to be the branch ciuct type (5/6, p=0.01). Conclusions: A hyperplastic lesion can be predicted if a lesion is the branch duct type of IPMT with the diameter of the main pancreatic duct < 7 mm and without symptoms. Therefore, IPMT of the pancreas with these findings can be followed up without an operation. (Korean J Gastrointest Endosc 2000;20:443- 448)

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증례 : 식도궤양과 호맹판 궤양을 동반한 베체트병 1예 ( A Case of Behect's Disease with Esophageal and Beocecal Valve Ulcers ): Korean J Gastrointest Endosc 2000;20(6):449-455. Published online November 30, 1999

Abstract PDF: Behcet's disease is a multisystemic, chronie inflammatory disease with a triad of symptoms including oral ulcers, genital ulcers, and inflammatory ocular lesions. While intestinal Behcet's disease commonly affects the ileocecal region, esophageal ulceration with odynophagia is very uncommon. A 38-year-old male patient was admitted due to odynophagia, a postprandial epigastric burning sensation, and right lower quadrant abdominal pain. He had a history of recurrent oral and genital ulcerations, An esophagogastroduodenoscopy revealed relatively well demarcated ulcerative lesions with mucosal nodiularities on the mid to distal esophagus which was suspected to be esophageal cancer. But repeated biopsies showed lymphocytic and plasma cell infiltrations on the lamina propria. A colonoscopy revealed a well demarcated, deep ulcerative lesion with stenotic narrowing in the ileocecal valve. The diagnosis of intestinal Behcct's disease with an esophageal ulcer was made on the basis of clinical and pathological findings. The patient was treated with steroids and sulfasalazine and the response was favorable. (Korean J Gastrointest Endosc 2000;20:456-459)

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원저 : 악성 담도 폐쇄에서 금속 배액관 삽입 후 강내 방사선 치료의 효과 ( The Efficacy of Intraluminal Radiotherapy after Metallie Stent Insertion in Malignant Biliary Tract Obstruction ): Korean J Gastrointest Endosc 2000;20(6):449-455. Published online November 30, 1999

Abstract PDF: Background
/Aims: Inoperable malignant biliary tract obstructions (MBTO) are best palliated by drainage procedures followed by radiation therapy. In order to administer high doses in a short time to the central part of the tumor, internal radiotherapy has been proposed for a palliative goa1. The aim of this study is to investigate the effect of intraluminal radiotherapy (ILRT) to the stent patency and patients survival time after expandable metallic stent insertion in MBTO. Methods: Between August 1996 and July 1998, 28 patients (17 females, 11 males, average age 61.4 years) with inoperable MBTO were provided with percutaneous transhepatic biliary drainage (12 patients; bile duct cancer, 8 patients; pancreatic head cancer, 4 patients; gallbladder cancer; 4 patients; lymph node metastasis from stomach cancer). The 14 patients were treated by only metallic stent. The other 14 patients were treated by metallic stent insertion and followed by ILRT. The ILRT was done by iridium-192 (mean dosage 23.3 Gray, 5 fractions). Results: There were no significant differences in the two groups regarding age, sex, type of disease, and location of the obstruction. The patients tolerated ILRT well. Conclusions: The ILRT after expandable metallic stent was safe and effective in stent patency and the patient's surviva1 time in inopcrable MBTO. (Korean J Gastrointest Endosc 2000;20:449-455)

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증례 : 점막하 종양상을 보인 위궤양반흔 2예의 내시경적 초음파 단층촬영술상 ( Endosonographic Findings of Submucosal Tumor-like Gastric Lesion Caused by Fibrotic Ulcer Healing ): Korean J Gastrointest Endosc 2000;20(6):460-463. Published online November 30, 1999

Abstract PDF: It is known that multiple ulcers of the gastric antrum are often accompanied by marked submucosal fibrosis during the healing process, and that this may result in a deformity of the gastric wall. Thus, benign antral ulcers may be misinterpreted as intramural tumors, or even malignant ulcers when the surrounding edema is pronounced and sharply defined. It is possible for an endoscopic ultrasonography (EUS) to detect which layer has a submucosal tumor (SMT) in the five-layer structures of the digestive tract wall. In the diagnosis of SMT of the upper digestive tract, EUS allows for the visualization of the structures underlying the gastrointestinal wall in a noninvasive manner and has a great advantage over conventional modalities such as endoscopy and X-ray examination. The EUS findings of 2 cases of submucosal tumor-like gastric lesion caused by fibrotic ulcer healing are herein reported with a brief review of relevant literature. (Korean J Gastrointest Endosc 2000;20:460-463)

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증례 : 소화성 궤양에 속발된 중복유문 3예 - Helicobacter pylori 박멸 후 소실된 1예를 중심으로 - ( Three Cases of Double Pylorus Due to Gastroduodenal Fistula Complicating Peptie Ulceration - Disappearance of gastroduodenal fistula in 1 case after eradication of a Helicobacter pylori infection - ): Korean J Gastrointest Endosc 2000;20(6):464-467. Published online November 30, 1999

Abstract PDF: Double pylorus is either a congenital abnormality or an acquired complication of peptic ulcer disease. An accessory channel normally connects the lesser or greater curvatore of the prepyloric antrum with the duodenal bulb. Three cases of double pylorus, an unusual complication of peptic ulcer disease is herein reported. A peptic ulcer lay in the accessory channel in all cases. In one of the cases, the fistula closed spontaneously after Helicobacter pylori eradication. The remaining 2 patients became asympto-matic despite the persistence of the accessory channel. (Korean J Gastrointest Endose 200;20:464 467)

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증례 : 조기 위암을 동반한 위점막하 림프관 낭종 1예 ( A Case of a Gastric Submucosal Lymphatic Cyst Associated with Early Gastric Cancer ): Korean J Gastrointest Endosc 2000;20(6):468-471. Published online November 30, 1999

Abstract PDF: A lymphatic cyst of the stomach is rare benign tumor which is composed of thin-walled lymphatic space lined by benign-appearing endothelial cells. It rarely manifests clinical symptoms, so it is found incidentally in most cases. Recently, a case of submucosal lymphatic cyst associated with early gastric cancer was experienced. An endoscopy revealed a slightly elevated, edematous lesion adjacent to the malignant ulcer. This case is herein reported with a brief review of related literature. (Korean J Gastrointest Endosc 2000;20:468-471)

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증례 : 위장관 내 전이성 악성 흑색종 ( A Case of Metastatic Malignant Melanoma in Stomach ): Korean J Gastrointest Endosc 2000;20(6):472-476. Published online November 30, 1999

Abstract PDF: Malignant melanomas are common metastatic lesions in the gastrointestinal tract. There are some descriptions for endoscopic findings but few reports on the endoscopic ultrasonographic findings of metastatic malignant melanomas in the stomach. A 67-year-old woman was admitted due to indigestion persisting for 1 month. She had a 3×4 cm sized black pigmented skin lesion on her left foot. An abdominal ultrasonography and CT scan revealed multiple variable sized round lesions in the liver, suggesting metastatic lesions. An endoscopy revealed multiple, elevated lesions with central ulcerations and a star shaped black pigmentation around the ulcer mound on the antrum of the stomach, as well as huge ulcers with black pigmented bases on the upper body. An endoscopic ultrasonography determined that the depths of the elevated lesions on the antrum were 1imited to the mucosal layer and that huge ulcers on the upper body were invading the serosa simultaneously. The skin lesion was diagnosed as a malignant melanoma and the stomach lesion were also confirmed to be metastatic malignant melanomas. The case of malignant melanomas that metastased to the stomach and had unusual endoscopic ultrasonographic findings is herein reported. (Korean J Gastrointest Endose 2000;20:472 476)

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증례 : 대장중첩증을 유발한 가족성 선종성 용종증 1예 ( Colonic Intussusception in a Patient with Familial Adenomatous Polyposis - A Case Report - ): Korean J Gastrointest Endosc 2000;20(6):477-480. Published online November 30, 1999

Abstract PDF: A 26-year-old man with intermittent lower, abdominal, cramping pain, nausea, vomiting, and diarrhea was found to have intussusception by computed tomography. Whole emergency laparotomy was performed, intus-susception reduced spontaneously. Postoperately, familial adenomatous polyposis (FAP) was diagnosed by colonoscopy and barium enema. Innumerous polyps were found in the entire colon and one of these was presumed to have caused sigmoid invagination. If is believed that FAP is quite a rare cause of colonic intus-susception. This case of a 26-year-old man with an intussusception of the colon due to FAP is herein reported. It is important that surgeons and internists are aware of this rare cause of intussusception due to FAP because of the therapeutic implications. (Korean J Gastrointest Endosc 2000;20:477-480)

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증례 : 재발성 급성 췌장염을 계기로 발견된 췌장의 미소 Intraducta Papillary Mucinous Tumor 1예 ( A Case of Minute Intraductal Papillary Mucinous Tumor of the Pancreas Presenting with Recurrent Acute Pancreatitis ): Korean J Gastrointest Endosc 2000;20(6):481-485. Published online November 30, 1999

Abstract PDF: Intraductal papillary mucinous tumors (IPMT) of the pancreas is a lesion consisting of mucin-producing cells with neoplastic potential. This unique group of tumors is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. Now IPMT of the pancreas also includes intraductal papillary neoplasms that do not hypersecrete mucin. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are mild in severity. Recently, we was experienced a case of a minute IPMT causing repeated bouts of acute pancreatitis in a 75 year-old man. An endoscopic retrograde pancreatogram revealed a filling defect at the neck of the main pancreatic duct. A near-total pancreatectomy was performed and a minute (3×7 mm) IPMT of borderline malignancy was found in a branch duct at the pancreatic head. Surprisingly, despite the resective surgery the patient died of carcinomatosis. 8.5 months after the operation. This case of a minute but aggressive IPMT of the pancreas is herein reported with a review of the relevant literature. (Korean J Gastrointest Endosc 2000;20:481 -485)

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증례 : 과도하게 늘어난 십이지장 윤상주름의 클립 고정법을 이용한 ERCP ( The Application of Clips during ERCP: A New Anchoring Method for Redundant Kerckrings Folds Covering the Duodenal Papilla ): Korean J Gastrointest Endosc 2000;20(6):486-490. Published online November 30, 1999

Abstract PDF: During an endoscopic retrograde cholangiopancreatography (ERCP). cannulation is more difficult in patients with anatomical variations, papillary stenosis, an impacted stone in the papilla, papillary cancer, peripapillary diverticulum, postoperative states such as those after Billroth II or Braun operations, or redundant Kerckring's folds of the duodenum covering the duodenal papilla. For a patient suffering from a redundant Kerckrings folds of the duodenum and a common bile duct stone, a new technique applying clips to expose the duodenal papilla properly during ERCP was performed. After the application of the clips, the duodenal papilla was well exposed in a favorable position for proper cannulation. In this setting, an ERCP was easily performed with the standard cannula. After an endoscopic sphincterotomy (EST) with the pull-type papillotome was conducted, the common bile duct stone was successfully removed with a Dormia basket. (Korean J Gastrointest Endosc 2000;20:486-490)

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증례 : 담낭천공에 의한 이소성 담석의 내시경적 치료 2예 ( Two Cases of Ectopic Gallstones Treated by Endoscopic Therapy ): Korean J Gastrointest Endosc 2000;20(6):491-495. Published online November 30, 1999

Abstract PDF: Two cases are herein reported involving patients with ectopic gallstones which were discharged into the stomach and duodenum through a cholecystoduodenal fistula and successfully removed by endoscopic therapy. In the first case, a 75-year-old man was admitted with epigastric pain. Simple abdomen film demonstrated a round laminated calcification and air biliarygram in the RUQ. Endoscopic examination revealed a fistula on the posterior wall of the duodenal bulb and a brown stone (about 5 cm in diameter) was found in the second portion of the duodenum, It was demolished through endoscopic electrohydraulic lithotripsy (EEH1) and discharged with the stool. In the second case, a 55-year-old man was admitted with epigastric pain. A CT scan revealed an ovoid laminated calcification in the dependent portion of the stomach. Endoscopic examination revealed a fistula on the anterior wa11 of' the duodenal bulb and a black pigmented stone (about 2.5 cm in diameter) was found in the stomach. This stone was removed orally by an endoscopic snare. These patients were discharged and remained asymptomatic. (Korean J Gastrointest Endose 2000;20:491-495)

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증례 : 유두부로 개구하는 담낭관 급성 췌장염 - 증례보고 - ( Cystic Duct Insertion at the Ampulla of Vater and Acute Pancreatitis - A Case Report - ): Korean J Gastrointest Endosc 2000;20(6):496-498. Published online November 30, 1999

Abstract PDF: The two most common causes of acute pancreatitis are alcohol and cholelithiasis. Acute recurrent pancreatitis can result from a variety of abnormalities involving the terminal end of the distal choledochus, pancreatic duct, ampulla of Vater and the major duodenal papilla, which in turn may include a papillary stenosis, periampullary neoplasm, choledochocele, sphincter of Oddi dysfunction, and pancreatic ductal adenocarcinoma. Recently a case of recurrent acute pancreatitis associated with aberrant cystic duet insertion at the ampulla of Vater was experienced. Biliary-pancreatic reflux was speculated to be the mechanism responsible for causing this anomalous, recurrent, acute pancreatitis. Another case of acute pancreatitis associated with aberrant cystic duct insertion at the ampulla of Vater was also experienced in a 29-year-old man, 1Jnlike the previous report, our case showed cholestatic features on the initial blood chemistry. An endoscopic retrograde cholangiopancre-atography performed after recovry revealed only aberrant cystic duct insertion at the ampulla of Vater. This anomaly also seems to have played a role in causing acute pancreatitis in this patient. This interesting case is herein reported with a review of the relevant literature. (Korean J Gastrointest Endosc 2000;20:496-498)

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증례 : Helicobacter pylori 음성인 위장 MALT 림프종의 치료와 추적검사는?: Korean J Gastrointest Endosc 2000;20(6):499-500. Published online November 30, 1999

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증례 : Helicobacter pylori 음성인 위장 MALT 림프종의 치료와 추적검사는? (답변): Korean J Gastrointest Endosc 2000;20(6):501-501. Published online November 30, 1999

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